chest x rays Flashcards
what is important to check before you assess the x ray?
- name
- DOB
-medical record number
what does PIRE stand for in terms of assessing for quality?
-projection
-inspiration
-exposure
-rotation
how is an AP X-ray taken?
-plate is placed behind the person
-xray is taken from the front causing the heart to appear larger than on the PA
how is a PA xray taken?
-plate is placed in front of the person
-xray is taken from behind, this then hits the heart slightly later
are most x rays PA or AP?
PA
- the person is asked to move their arms to take their scapula away from the lung fields to make it easier to read
Why is a good inspiratory effort important on CXR?
it allows all of the structures to be more visible
what ribs should you see on a chest xray?
-5-6 anterior ribs (in blue in pic)
-9 posterior ribs (purple)
what condition might be present if there’s more than 6 anterior ribs visible on xray?
-COPD
what colours are air, bone and tissue on xray?
–air
-bone
-tissues
if toast is overdone, what colour is it
how do you assess for rotation on chest xray?
-the space between the medial clavicle and the margin of the adjacent vertebrae should be equal to each other
what are the important anatomical landmarks to see on a chest x ray?
-manubrium
-diaphragm / liver
-heart - sup VC, aortic arch, atriums, inferior VC
-left main bronchus
-right main bronchus
what is the systematic approach to read a chest xray?
-A- airways
-B-bones
-C-cardiac
-D-diaphragm
-E-effusions
-F-fields
-G-gastric bubble
-H- hardware
how to you read airway?
-check for position of the trachea and the carina
-is there any evidence of shifting of the structure ?
-is there an endotracheal tube in place?
what do you look out for in reading bones?
-fractures
-scoliosis
what do you look out for in terms of ‘cardiac’?
-check the ratio of the heart size: width of thorax (normal adult ratio is less than 50%)
-if heart is enlarged, it may indicate cardiomegaly, but you cannot judge this accurately on AP film
-check borders - edges of the heart should be clear which ensures nothing is obscuring this silhouette eg pulmonary oedema
what is an example of a condition in which the heart borders are blurred?
-pulmonary oedema
how to check the diaphragm on chest xray?
-check the position of the R & L semi-diaphragm, the right should be higher than the left due to the liver
-also should be a nice dome shape
-check for any flattening - can be seen in hyper inflated lungs as seen in COPD
-check cardio phrenic and cost phrenic angles on diaphragm
what is an effusion?
an accumulation of fluid in an anatomic space
how do you check for fields on an xray?
-check the lung fields - compare left to right lung
-are the volumes of the lungs equal?
-are there any differences overall?
what is consolidation?
-accumulation of solid or liquid material in the air spaces and lung parenchyma
-loss of silhouette
-increase in opacity (ie quality)
what would a Lower lobe collapse look like on an xray?
-increased opacity
-loss of silhouette
what is a gastric bubble and what does it look like on a chest xray?
-gas in the fundus of the stomach - completely normal
-seen in approx 70% of chest X-rays
how many anterior ribs should you see on an adequately inspired chest xray?
5-6
which hemidiaphragm sits higher on chest xray?
the right
what do you look for of hardware on chest x rays?
-any medical lines or devices attached to the person
-ECG (left)
-nasogastric tube (right)
